Histoplasmosis This is a disease caused by the fungus Histoplasma capsulatum.  In the United States it is most commonly found in the central and eastern states.  It can also be found in Africa, Southeast Asia, Canada, Mexico, Central America and South America. The fungus has two separate physical forms: one that is inhaled, called conidia; and a second, which results from converting the aerosol form to budding cells in the lungs.  From here, the fungus spreads through the bloodstream.  Most cases of Histoplasmosis do not cause symptoms or cause a mild flu-like illness (cough, body aches, etc.) lasting 1-15 days, depending on severity.  There are four types of Histoplasmosis infections that cause more severe syndromes listed below. Chest X-Ray may show focal Pneumonia, progressive changes especially in the apices of the lungs, or a miliary pattern depending on the clinical syndrome. Laboratory Anemia or chronic disease is usually present in those with chronic lung disease Bone marrow biopsy may show infection in disseminated disease Alkaline phosphatase, LDH, and ferritin levels may be elevated Urine antigen assay is 90% sensitive for diagnosing disseminated disease Complement fixation titers in the serum are 80% sensitive for lung disease Progressive localized disease and mild-moderate disease -- Itraconazole orally.  Amphotericin B intravenously is used for those who fail treatment. Severe or disseminated disease -- intravenous amphotericin B.  Patients with AIDS and Histoplasmosis need life-long suppressive therapy with oral Itraconazole after treatment with intravenous Amphotericin. Coccidioidomycosis Tuberculosis Pneumocystosis Atypical Pneumonia Syndromes Acute Histoplasmosis -- person is very ill and has fever, but minimal lung complaints (even if a Histoplasmosis Pneumonia is present).  Usually lasts 1 week to six months, but is almost never fatal. Progressive disseminated Histoplasmosis -- cough, shortness of breath, fever, person feels very ill, loss of weight, and liver, spleen and adrenal glands are usually enlarged.  There may be ulcers in the mouth.  This syndrome can be fatal within six weeks especially without treatment. Chronic progressive pulmonary Histoplasmosis -- usually occurs in older patients with COPD (Emphysema or chronic Bronchitis).  It causes progressive lung damage. Disseminated disease in immunocompromised patients (e.g., on chemotherapy or has AIDS) -- person has fever and the Histoplasmosis can affect many different organs, including the meninges (causing Meningitis).  The chest X-Ray may show a diffuse pattern of involvement (miliary pattern).  Patients come to the hospital in shock.  Death usually occurs rapidly without treatment.